New report shows VAD laws are fulfilling their promise
For the first time, analysis of official data from all Australian jurisdictions presents a snapshot of VAD in practice; who is using the laws and what can be improved.
More than 2,460 terminally ill Australians have ended their life using voluntary assisted dying (VAD) since end-of-life choice was first legalised, a landmark report from Go Gentle Australia has found.
The State of VAD report collates and analyses available VAD data for the first time. It reveals a good news story: Australia’s laws are operating safely within the parameters set out by parliament and are fulfilling their dual aims to offer terminally ill people choice and relieve suffering. The report finds that in Australia;
- A typical VAD applicant is aged 70-79 years, more likely to be male, and have cancer
- The majority are well educated, speak English as their preferred language and around 4 in 5 (79%) are receiving palliative care
- Health professionals are delivering compassionate, person-centred care to people who seek this choice.
The report shows that while assisted deaths represent a small proportion of all deaths (between 0.5 and 1.6%) demand for VAD services is growing. A number of reforms are recommended to further improve access, including:
- Streamline complex bureaucratic processes
- Recognise VAD as part of high-quality end-of-life care and include it in clinical standards
and guidelines - Grow the VAD health workforce to meet demand, with fair compensation
- Produce clear guidance to individual practitioners, hospitals, hospices and aged care facilities about their legal and ethical obligations to the people in their care
- Provide culturally safe resources and services for First Nations peoples and those from culturally and linguistically diverse backgrounds.
The report includes a joint statement from health organisations calling on the government to reform the Commonwealth Criminal Code where it restricts VAD access for rural and remote Australians.
A revolutionary pace of change
Andrew Denton, Go Gentle Australia’s founding director, said enormous progress had been made since Victoria became the first state to pass a VAD law in 2017.
"But there is more work to do. The Northern Territory is still to pass a law and we must ensure no one is left behind. There is also the business of making services as accessible as possible for those who need them. We must never forget who these laws were written for – terminally ill people who are suffering intolerably and want some control over the timing and circumstances of their death.”
VAD applicants three times more likely to die at home
Dr Linda Swan, Go Gentle Australia’s CEO, said: “The evidence collected paints a reassuring picture of systems fulfilling their aims.
"The State of VAD is overwhelmingly a good news story. None of the dire predictions from opponents have come to pass and systems are working safely and with great compassion.”
Dr Swan said VAD applicants were of all ages and backgrounds but typically aged between 70 and 79. They were slightly more likely to be male, have a terminal cancer diagnosis and on average took between two weeks and a month to progress through the approvals process.
“Applicants are being guided by more than 1,000 VAD-trained health professionals and kind and meticulous support services,” Dr Swan said.
“We hear many stories of health professionals going above and beyond to ensure terminally ill people and their families get the support they need.
“Importantly, around 80 per cent of applicants are receiving palliative care which demonstrates the two care options can and do work together, offering opportunities for closer co-operation.”
Dr Swan said the data revealed a further benefit; that VAD was enabling more people to die at home.
“The vast majority of us say we want to die at home but only around 15 per cent of us manage to do so. VAD applicants are achieving this goal at three times that rate.”
Greater awareness needed
However, challenges remain. A number of barriers were preventing access for otherwise eligible people, and a funding shortfall for VAD providers risked the sustainability of services.
“Between 30 and 50 per cent of people who start the process do not complete it, and one in five who are found eligible die without using the VAD substance," Dr Swan said.
"VAD is a person-directed process. However, it may be that barriers are preventing eligible applicants from completing the process. We need more information to determine whether there is an imbalance between safeguards and accessibility.”
Greater awareness of VAD was essential.
“People can only benefit from the choice if they know it exists. So-called ‘gag clauses’ in Victoria and South Australia prevent health professionals from raising the topic with patients. No other health care requires patients to know their treatment options before consulting a doctor. It runs contrary to person-centred and informed care.
“Another challenge was encouraging enough clinicians to complete VAD training to meet demand. We need to ensure health professionals are fairly remunerated and suppported for their VAD work. Some VAD practitioners are working after hours and on weekends, and receiving little or no financial compensation.”
Health agencies call for Criminal Code reform
A priority is reform of the Commonwealth Criminal Code, to allow the use of electronic communications, including phone, email and telehealth, in the VAD process. In a joint statement, 17 leading health agencies have joined Go Gentle to call on the federal government to urgently amend the Code where it negatively impacts provision of VAD services, particularly in regional and remote areas.
“It is cruel and unreasonable to require dying people to travel long distances to in-person consults for every single aspect of the application process,” Dr Swan said. “This outdated
prohibition adds significant delays and uncertainty for everyone, and discriminates against people in rural and remote areas.”